BMJ 2001;322 ( 31 March )

Editor's choice

Black dog

Dog eared wounds come in three varieties, Minerva reminds us: the standing full cone, the lying half cone, and the pseudo dog ear (p 806). Making the incision more than three times longer than it is wide avoids most problems. And don't expect a dog ear to settle on its own because it won't.

Would that such straightforward advice was possible for other problems identified this week, especially the three Dsdistress, depression, and dementia. They hover over this week's journal like a cloud.

Commenting on Reid and colleagues' study of medically unexplained symptoms in frequent attenders of secondary health care (p 767), Turner sees a large amount of underlying distress "that is neither appropriately identified nor addressed" (p 745).

Although exercise has emerged as one of the panaceas of the age (and for the agedsee p 796), it doesn't seem to work for depression. A systematic review of randomised controlled trials found no particular benefit (p763). In another study Chilvers and colleagues report that generic counselling may be as good as antidepressant drugs for mild to moderate depression, although drugs act faster (p 772).

We've known for some years of the distress of relatives caring for people with dementia. Margallo-Lana and colleagues looked at the psychological health of staff caring for such people. Although levels of distress were lower than those reported among other healthcare workers and relatives caring for people with dementia, they highlight the importance of "positive coping strategies" (p 769). This week's instalment of the care of older people reviews mental health problems in detail. Baldwin and colleagues tell us that depression is the commonest mental health disorder in later life: it is "eminently treatable, but psychological therapies are underused" (p 789).

Depression and distress lurk amid the reviews. In later life, "boarding school survivors" may experience stress related disease, inability to sustain meaningful intimate sexual relationships, and mental and emotional breakdowns, says a review of The Making of Them: The British Attitude to Children and the Boarding School System (p 803). And to finish us off, Soundings describes two variants of Barraclough's syndrome where depression follows whiplash, litigation, and breakup with boyfriend, or where depression follows whiplash and litigation alone (p 805).

Respite comes, as it so often does, from the obituaries (pp 800-1). Leslie Lauste "had a love of foreign travel, always with a historical purpose, such as a search for Xanadu." At the time of his death John White was planning the world's largest "ring of roses" with 1500 children.

Footnotes

To receive Editor's choice by email each week subscribe via our website: www.bmj.com/cgi/customalert

---

© BMJ 2001
CiteULike    Complore    Connotea    Del.icio.us    Digg    Reddit    Technorati    What's this?

Relevant Articles

Medically unexplained symptoms in secondary care

Jane Turner
BMJ 2001 322: 745-746. [Extract] [Full Text] [PDF]

Medically unexplained symptoms in frequent attenders of secondary health care: retrospective cohort study

Steven Reid, Simon Wessely, Tim Crayford, and Matthew Hotopf
BMJ 2001 322: 767. [Abstract] [Full Text] [PDF]

Longitudinal comparison of depression, coping, and turnover among NHS and private sector staff caring for people with dementia

M Margallo-Lana, K Reichelt, P Hayes, L Lee, J Fossey, J O'Brien, and C Ballard
BMJ 2001 322: 769-770. [Full Text] [PDF]

Antidepressant drugs and generic counselling for treatment of major depression in primary care: randomised trial with patient preference arms

Clair Chilvers, Michael Dewey, Katherine Fielding, Virginia Gretton, Paul Miller, Ben Palmer, David Weller, Richard Churchill, Idris Williams, Navjot Bedi, Conor Duggan, Alan Lee, and Glynn Harrison
BMJ 2001 322: 772. [Abstract] [Full Text] [PDF]

Care of older people: Mental health problems

Alistair Burns, Tom Dening, and Robert Baldwin
BMJ 2001 322: 789-791. [Extract] [Full Text] [PDF]

A healthy old age: realistic or futile goal?

Piers Simey, Dawn Skelton, Matthew Parsons, and Ann McLaughlin
BMJ 2001 322: 796. [Extract] [Full Text]

Kenneth Barlow • John Patrick Macrae Bensted • John David Waite Fisher • Leslie Wallace Lauste • William Robert Moore • Nigel Geoffrey Nicholson • David Harry Pickett • Cyril Taylor • Hermon Taylor • John Edward White

Joanna Ray, Richard Carter, William N Landells, Tony Missen, G Gordon Steel, A B Goorney, R L Symonds, Philip Somerville, Christopher Jephcott, G B Whitaker, Robert G Jones, H Silver, John Blandy, and G M Fairris
BMJ 2001 322: 800. [Extract] [Full Text] [PDF]

Book: The Making of Them: The British Attitude to Children and the Boarding School System

Petruska Clarkson
BMJ 2001 322: 803. [Full Text]

Doctors on the ropes

Richard Hayward
BMJ 2001 322: 805. [Full Text]

Minerva
BMJ 2001 322: 806. [Full Text] [PDF]